Drug Costs

SOTU: Two Proposals In Tension

February 5, 2019 10:57 am

President Donald Trump is set to give his State of the Union address this evening. White House staff members began previewing the remarks with reporters late last week, and we now know two things about the healthcare portion of the speech: drug prices will be addressed and the president will put the nation on a path to ending HIV by 2030.


That latter goal, however, is in tension with the Trump administration’s proposal to link U.S. drug prices to prices paid in other countries.


Since HIV and AIDS treatments came onto the market in the 1990s, the number of AIDS deaths in the United States has dropped from 500,000 annually in 1995 to less than 7,000 today. As Dr. W. David Hardy, adjunct professor at Johns Hopkins University School of Medicine, recently explained at STAT News, pharmaceuticals not only help individuals live longer, they help prevent HIV transmission since “individuals with undetectable amounts of HIV in their bodies, the result of effective treatment, cannot transmit HIV to others.” “That,” Hardy said, “Is a powerful tool for ending the HIV epidemic.”


Hardy argued that using the International Pricing Index (IPI), as the Trump administration has proposed, would create “obstacles” that could keep individuals living with HIV from getting the treatments they need. He also raised concerns about step therapy and prior authorization, two other planks of the Trump administration’s proposal to cap physician-administered drugs under Medicare Part B. Hardy noted these proposals run “counter to the goals in federal HIV treatment guidelines and the National HIV/AIDS Strategy to start antiretroviral treatment as soon as possible following diagnosis, to avoid lapses in treatment and to help individuals take their medications as prescribed.”


In a recent column in The Hill, Jesse Milan Jr., president and CEO of AIDS United, also outlined problems with step therapy and prior authorization. Milan said the Trump administration proposal would give “tremendous authority to insurance companies to make decisions about treatment, decisions that should be left to individuals and their doctors.” He warned, “We’ve seen what happens when insurers have this kind of power — people lose access to the treatments they need. And people die.”


AIDS Institute Deputy Executive Director Carl E. Schmid also opposed using the IPI. He said, “The Trump administration proposal is bad medicine and dangerous to people living with HIV. … [T]here is no reason to take these draconian actions.” In a statement issued last November, the AIDS Institute advised, “Providers are best able to prescribe the HIV drug that works best for the patient, who may have resistance to certain drugs, comorbidities or side-effects that dictate the drug that they are able to take.”


The United States can end HIV and HIV transmissions, but access to life-saving and life-sustaining medications are an important part of achieving that goal.